Healthcare Provider Details

I. General information

NPI: 1831533587
Provider Name (Legal Business Name): WILLIAM A RISK PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2013
Last Update Date: 05/27/2021
Certification Date: 05/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 WITCH DUCK CT
HEATHSVILLE VA
22473-2336
US

IV. Provider business mailing address

702 RIDGE RD
CALLAO VA
22435-2445
US

V. Phone/Fax

Practice location:
  • Phone: 804-580-1935
  • Fax:
Mailing address:
  • Phone: 804-580-1935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP7744
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305202048
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: